Tomando Control de su Salud

Take Control of Your Health Program

Workshop Checklist summary

Date

Session Attended

Peer Leader

Observer

County

Number of Participants in Class

Skills	Comments/Suggestions
Class Prep

Arrived on time with materials/charts.

Room appropriate re: protecting confidentiality, seating arranged in a “U” or circle, lighting, temperature, ADA, noise and distractions, ability of all trainees to see and hear, charts were legible handwriting, dark colored marking pens, easily readable.
Delivery of program

Followed the curriculum as scripted in the Peer Leader Manual.

Clearly explained topics and activities.

Presentation style appropriate; articulate, eye contact, inflection.

Modeled activities correctly.

Positively reinforced participants.
Group Interaction

Encouraged group participation.

Limited personal stories.

Handled problem people effectively.

Adhered to timelines.

Worked well as a partner with co-leader.
Brainstorming

Encouraged to produce as many ideas as possible.

Repeated ideas.

Reminded group not to comment on ideas.

Did not allow discussion/questions.

Used silence.

Person writing did not lead activity.

Offered own response only at end.

Reviewed the list by reading ideas.

Provided opportunity for clarification.
Action Planning

Used chart to point out steps as trainees shared their action plans.

Pointed out “will” if participant used “try”, “should”, “want” or “think”.

Helped identify barriers if confidence level was less than 7.

Asked the group for suggestions before the leaders offered responses.

Used the diagram of Action Plan, Appendix II
Feedback/Problem Solving

Asked person to state their action plan and success/problems.

Complimented appropriate action plan adjustment/modification.

If problems, what barriers existed and did they try a solution?

Asked person if they would like help.

Asked group if they ever had same/similar problem.

Conducted brainstorm appropriately.

Limited to 3 “yes, buts”.

Offered the person to choose one idea.

Recommended that person make a note of suggestions offered.

Used the diagram of Sharing Experiences, Appendix II
Fidelity

Delivered all content materials according to the current Stanford leaders’ manual (2013).

Accurately paraphrased sections of activities (provided info clearly, without adding or deleting material that changed the content).

Distributed and collected appropriate data collection forms.
Additional Comments:

Signature of Peer Leader

Signature of Observer

Tomando Control de su Salud

Session 1 Fidelity Checklist

Item	Comments
___	Agenda posted, name tags available, books, copies of daily meal plan.

___	Pens and paper for notes.

___	Sign-in Sheet distributed/Attendance Log available.

___	Read Group Leader Script.

___	Participant Information Survey distributed and collected.

___	Charts 2, 3, 6, 7 and 8 posted.
Activity #1 – Introduction to the Program and Responsibilities
___	Introduction to Tomando program, chart 1 to 3.

___	Distributed copy of workshop topics and weekly homework.

___	Accurately delivered content of chronic condition.

___	Reviewed guidelines in chart 3.
Activity #2 – Introduction to the Group
___	Modeled introductions.

___	The co-leader wrote answers on the board.
Activity #3 – Managing Your Symptoms
___	Accurately delivered content, reviewed and posted charts 2, 4 and 5.

___	Guided through lemon activity slowly.

___	Timed distraction techniques correctly.
Activity #4 – The Importance of Diet and Exercise
___	Accurately delivered content.

___	Explained brainstorm guidelines, chart 6.

___	Followed the correct brainstorm guidelines.

___	Copies of daily meal plan.
Activity #5 – Sleeping Well During the Night
___	Accurately delivered content.

___	Followed the correct brainstorm guidelines.
Activity #6 – Introduction to the Action Plan
___	Delivered the content and presented info, chart 7.

___	Modeled action plan.

___	Asked for volunteer to report on action plan.

___	Summarized each action plan by using the standard:

___	Something YOU WANT to do

Achievable

Action specific

Answers what, how much, when, how often, confidence level of 7 or more

___	Used correctly the diagram of Action Plan, Appendix II.

___	For confidence levels less than 7, guided through identification of barriers.

___	Informed participants leaders will be calling them to support them in their plans.
Activity #7 – Closing
___	Reviewed 6 items.

___	Followed activity timelines, class ended within 2-1/2 hours.

Tomando Control de su Salud

Session 2 Fidelity Checklist

Item	Comments
___	Agenda and charts 2, 3, 6, 7 and 8, and 9 to 12 posted.

___	Charts were legible handwriting, dark colored marking pens, easily readable, name tags available, books and CD’s.
Activity #1 - Feedback/Problem Solving
___	Modeled Action Plan.

___	Encouraged participants to share their action plan.

___	If the action plan is not achieved:

asked participant about barriers and if they tried a solution

asked if help is wanted from the group, if yes:

asked if anyone else from the group ever had a similar problem

___	Conducted brainstorm appropriately.

___	Limited to 3 “yes, buts”, offered the person to choose one idea.

___	Recommended person make a note of suggestions offered.

___	Modeled problem-solving steps appropriately; reviewed chart 8.

___	Used correctly the diagram of Sharing Experiences, Appendix II.
Activity #2 – A Healthy Menu
___	Daily meal plan report.

___	Accurately presented topic and charts 9 and 10.

___	Briefly reviewed pages 190-191 (edition 2013) Tomando Book.

___	Presented a visual drawing of a healthy plate.

___	Identified nutrition value for a portion of rice and a portion of tomatoes.

___	Broke people into groups and conducted group practice in preparing a healthy menu.

___	Encouraged participants to use these guidelines for a daily meal.
Activity #3 – Exercise for Your Health
___	Reminded participants of last week’s topic on the benefits of exercising.

___	Accurately presented topic and review of chart 11.

___	Clearly explained establishing baseline with time and/or distance examples.
Activity #4 – Exercise Practice
___	Set fitness CD prior to activity.

___	Informed participants these exercises can be done at home.

___	One Peer Leader modeled the exercise routine.

___	One Peer Leader walked around the room.
Activity #5 – Avoiding Falls and Improving the Physical Balance
___	Accurately presented information.

___	Followed the guidelines of brainstorm.

___	Chart 12

Activity #6 – Action Plan
___	Presented info on chart 7.

___	Modeled action plan.

___	Asked for volunteer to report on action plan.

___	Summarized each action plan by using the standard:

___	Something YOU WANT to do

Achievable

Action specific

Answers what, how much, when, how often, confidence level of 7 or more

___	Used correctly the diagram of Action Plan, Appendix II.

___	For confidence levels less than 7, guided through identification of barriers.
Activity #7 - Closing
___	Reviewed 6 items; asked members to exchange phone numbers to help each other.

___	Followed activity timelines, class ended within 2-1/2 hours.

Tomando Control de su Salud

Session 3 Fidelity Checklist

Item	Comments
___	Agenda and charts 2, 3, 6, 7 and 8, and 13 to 16 posted.

___	Charts were legible handwriting, dark colored marking pens, easily readable, name tags available.
Activity #1 - Feedback/Problem Solving
___	Modeled action plan; stated action plan and level of success; asked for volunteer.

___	Complimented appropriate action plan adjustment/modification.

___	If action plan was not achieved:

asked participant about barriers and if they tried a solution.

asked if help is wanted from the group, if yes:

asked if anyone else from the group ever had a similar problem.

___	Conducted brainstorm appropriately.

___	Limited to 3 “yes, buts”, offered the person to choose one idea.

___	Recommended person make a note of suggestions offered.

___	Modeled problem-solving steps appropriately; reviewed chart 8.

___	Used correctly Action Plan and Sharing Experiences diagrams, Appendix II.
Activity #2 – Choosing Healthy Food
___	Conducted questions appropriately.

___	Broke people into groups and conducted group practice on how to prepare a low fat menu.

___	Accurately presented info on chart 13.

___	Asked participants to bring a healthy dish or recipe on the last day of the workshop.

___	Asked participants to bring food labels for the following class.
Activity #3 – Making Decisions
___	Accurately presented info on charts 2, 14 and 15.

___	Accurately delivered the content.

___	Broke people in partners and conducted group practice in making decisions.
Activity #4 - Better Breathing
___	Accurately delivered material and review of chart 16.

___	Correctly demonstrated pursed lip and diaphragmatic breathing technique
Activity #5 - Muscle Relaxation
___	Informed participants their participation in muscle relaxation is optional, created environment conducive to relaxation exercise.

___	Informed participants the script is in the book or they can order the CD.
Activity #6 – Closing
___	Reviewed 6 items.

___	Followed activity timelines, class ended within 2-1/2 hours.

___	Encouraged participants to call their buddy.

Tomando Control de su Salud

Session 4 Fidelity Checklist

Item	Comments
___	Agenda and charts 2, 3, 6, 7 and 8, and 17 to 21 posted.

___	Charts were legible handwriting, dark colored marking pens, easily readable, name tags available.
Activity #1 - Feedback/Problem Solving
___	Modeled action plan, stated action plan and level of success, asked for volunteer.

___	Complimented appropriate action plan adjustment/modification.

___	If action plan is not achieved:

asked participant about barriers and if they tried a solution.

asked if help is wanted from the group, if yes:

asked if anyone else from the group ever had a similar problem.

___	Conducted brainstorm appropriately.

___	Limited to 3 “yes, buts”, offered the person to choose one idea.

___	Recommended person make a note of suggestions offered.

___	Modeled problem-solving steps appropriately; reviewed chart 9.

___	Used correctly Action Plan and Sharing Experiences diagrams, Appendix II.
Activity #2 – Reading Food Labels
___	Accurately delivered material and presented info on chart 17.

___	Conducted group activity.

___	Distributed the daily meal plan.

___	Asked the questions correctly.
Activity #3 – Endurance Exercises
___	Clearly defined content, using charts 4 and 18 to 20.

___	During endurance monitoring, one leader exercised while sitting and the other stood up.

___	Clearly explained establishing baseline with time and/or distance examples.
Activity #4 – Depression Management
___	Utilized chart 4 appropriately.

___	Conducted brainstorm appropriately.

___	Reminded participants alcohol and some drugs can make depression worse.

___	Noted need for professional treatment for severe depression.
Activity #5 – Positive Thinking
___	Accurately delivered information.

___	Allowed time for participants to suggest changes for negative emotions.

___	Utilized chart 21 appropriately.
Activity #6 - Closing
___	Reviewed 6 items, encourage choosing new buddies to call.

___	Followed activity timelines, class ended within 2 ½ hours.

Tomando Control de su Salud

Session 5 Fidelity Checklist

Item	Comments
___	Agenda and charts 2, 3, 6, 7 and 8, and 22 to 29 posted.

___	Charts were legible handwriting, dark colored marking pens, easily readable, name tags available.
Activity #1 - Feedback/Problem Solving
___	Modeled action plan, stated action plan and level of success, asked for volunteer.

___	Complimented appropriate action plan adjustment/modification.

___	If action plan is not achieved:

asked participant about barriers and if they tried a solution.

asked if help is wanted from the group, if yes:

asked if anyone else from the group ever had a similar problem.

___	Conducted brainstorm appropriately.

___	Limited to 3 “yes, buts”, offered the person to choose one idea.

___	Recommended person make a note of suggestions offered.

___	Modeled problem-solving steps appropriately; reviewed chart 9.

___	Used correctly Action Plan and Sharing Experiences diagrams, Appendix II.
Activity #2 – Maintaining a Healthy Weight
___	Delivered content according to manual.

___	Accurately presented info on chart 22.

___	Asked for a volunteer to share 1 or 2 things learned from the daily meal plan.
Activity #3 – Communication Skills
___	Delivered content according to manual, clearly explained “I” messages.

___	Accurately presented info on chart 23.
Activity #4 – Responsibility in Taking Medication
___	Clearly defined content, used charts 24 to 26.

___	Conducted brainstorm appropriately.
Activity #5 – Evaluating Home Remedies and Other Alternative Treatments
___	Delivered content according to manual and chart 27.

___	The co-leader wrote the home remedies on the board.
Activity #6 – Knowledge is Power
___	Conducted brainstorm appropriately.

___	Clearly defined content, used chart 28 and 29.

___	Asked participants to look for some resources in their community.
Activity #7– Closing
___	Reviewed 5 items.

___	Followed activity timelines, class ended within 2-1/2 hours.

___	Encouraged participants to call their buddy.

Tomando Control de su Salud

Session 6 Fidelity Checklist

Item	Comments
___	Agenda and charts 2, 3, 6, 7 and 8, and 30 posted.

___	Charts were legible handwriting, dark colored marking pens, easily readable, name tags, available
Activity #1 - Feedback/Problem Solving
___	Modeled action plan, stated action plan and level of success, asked for volunteer, asked if they found community resources.

___	Complimented appropriate action plan adjustment/modification.

___	If action plan is not achieved:

asked participant about barriers and if they tried a solution.

asked if help is wanted from the group, if yes:

asked if anyone else from the group ever had a similar problem.

___	Conducted brainstorm appropriately.

___	Limited to 3 “yes, buts”, offered the person to choose one idea.

___	Recommended person make a note of suggestions offered.

___	Modeled problem-solving steps appropriately, reviewed chart 9.

___	Used correctly the Sharing Experiences diagram, Appendix II.
Activity #2 – Working with Your Health Care Professional
___	Clearly defined health care system compared to health care provider.

___	Conducted brainstorm appropriately.

___	Reviewed charts 2 and 30.
Activity #3 – Exercises Practice
___	Used appropriate fitness CD.

___	One peer leader modeled the exercise routine.

___	One peer leader walked around the room.
Activity #4 – Looking Back/Sharing Accomplishments
___	Conducted brainstorm appropriately.

___	Used charts 2 and 4.

___	Participants shared accomplishments.

___	Pointed out that participants helped each other.
Activity #5 – Planning for the Future
___	Clearly modeled future goals and steps to reach the goal.

___	Problem solved if appropriate.

___	Guided through accomplishing future goals activity slowly.
Activity #6 – Celebration
___	Certificates prepared and distributed.

___	Distributed and collected Workshop Evaluation form.

___	Peer Leaders complete Workshop Information Cover Sheet.

Tomando Control de su Salud

WORKSHOP CHECKLIST SUmmary

(Continued)

ACS-32

JUL 14	-5-

JUL 14

JUL 14	-9-

Session 2 Fidelity Checklist

ACS-32, TCYH, Tomando Control de Su Salud, Workshop Checklist Summary, Master Trainer Checklist for Observing Peer Leaders

ACS-32, fidelity documents, workshop checklist summary, TCYH, Tomando Control de Su Salud, take control of your health, master trainer checklist for observing peer leaders

Windows User

2014-07-30

human services